Blue Jay Consulting/EMF Emergency Department Director of the Year Award

This form must be completed entirely. Do not indicate "see C.V."*You will upload supporting documents (Nomination Letter, Letters of Support and Abbreviated CV) on the next page.

Nominated By:

Date Submitted:

Address:

City, State, ZIP:

Valid E-mail:

Telephone:

Nominee

Name of Nominee:

Address:

City, State, ZIP:

Valid E-mail:

Telephone:

Communications Department (To be contacted if selected for the award):

Name of Contact:

Telephone:

Institution Name:

Valid E-mail:

Successful emergency departments have the strongest collegial relationships between medicine and nursing. It is through this collaboration that lasting improvements are made in quality care and patient satisfaction. Please state why this person should be honored with this award, with specific attention to the following criteria. The nominee must demonstrate collaborative relationships with nursing to implement and improve operational and clinical standards in the following areas: Quality Patient Care, Operational Effectiveness, Education, Community Service, and a synergistic approach to leadership within the hospital or hospital system. The nominee will create and sustain a high degree of patient satisfaction with emergency care delivery and will implement creative and innovative strategies to address ED throughout.

ACEP Offices Held (National and Chapter):

Committees (National, Local/Name of Committee, and Length of Service):

Other Emergency Medicine-Related Services (Title and Length of Service):

Other Activities of Special Merit (Civic, Institution, etc.):

AFTER YOU CLICK THESUBMIT BUTTON BELOW, YOU WILL BE DIRECTED TO UPLOAD THE SUPPORTING DOCUMENTS (Nomination Letter, Letters of Support and Abbreviated CV).